S4E3 Flashcards
Oncologic emergencies involving Cardiovascular
Malignant pericardial effusion
Pericardial tamponade
Superior vena cava syndrome
Oncologic emergencies involving CNS
Increase intracranial pressure
Metastatic spinal cord compression
Oncologic emergencies involving ortho
Pathologic fractures
Oncologic emergencies involving renal
Ureteral obstructions
⬇️
Pelvic tumors
Oncologic emergencies involving respiratory 🫁
Airway obstruction
Pneumothorax
Malignant pleural effusion
Oncologic emergencies involving GI 🤰🏽
Bowel obstruction
Bowel perforation
Metabolic Oncologic emergencies
Hyperuricemic Syndrome
Hypoglycemia
Hypercalcemia
Tumor lysis syndrome
Lactic acidosis
Hyponatremia & SIADH
Hyperkalemia
Hypokalemia
Types of Hypokalemia metabolic oncologic emergencies
Tumor associated
Treatment related (hyperemesis/diarrheal losses)
Hematologic Oncologic emergencies
Leukosis
Disseminated intravascular coagulation
Hyper viscosity syndrome
Myelosuppression(Profound thrombocytopenia )
Thromboembolic disease
Acute hemolytic anemia
Infectious Oncologic emergencies
Myelosupression⬇️
Febrile neutropenia / Nadir Sepsis
Disseminated viral infections
Leukemia
Cancer of WBC
Uncontrolled replication of Immature WBC
Cause of leukemia
Unknown
Dx test for leukemia
Repeated CBC
Positive Bone biopsy
Lymph node biopsy
Lumbar puncture : meningeal involved
Leukemia symptoms
Wt loss
Fever
Frequent infections
Easy SOB
Weakness
⬇️perfusion
⬇️o2 sat
Bone/joint pain
Muscle weakness
Fatigue
Loss of appetite
Swollen lymph nodes
Spleen/liver enlargement
Easy bruising/bleeding
Purplish patches/spots
Night sweats
Headache
Orthostatic hypotension
Pallor
Leukemia signs
⬇️⬆️WBC
⬆️Monocytes
⬆️lymphocytes
⬆️neutrophils
⬇️RBC
⬇️platelets
⬇️H&H
Thrombocytopenia
Anemia
What is ALL
Acute lymphocytic leukemia
<15 years old
Mostly lymphoblast and bone marrow
Acute =most troublesome
Rapid onset = rapid rapid rapid
⬇️RBC
⬇️platelets
⬆️ immature WBC
Quicker intervention =better outcome
What is AML
Acute Myelogenous Leukemia
15-39 years old
Mostly myeloblasts in bone marrow
Acute= troublesome
Rapid onset= rapid rapid rapid
Infection
Bleeding
Pain from enlarged spleen/liver
Hyperplasia of gums
Bone pain
What is CLL
Chronic lymphocytic leukemia
Most common
>50 years old
Mostly lymphocytes in bone marrow
B-cell lymphocytes
Dx w/o symptoms
Tx: chemo & monoclonal antibodies
What is CML
Chronic myelogenous leukemia
>50 years old
Mostly granulocytes in bone marrow
SOB
Confusion
Long bone pain
Liver/spleen enlargement
Leukemia risk factors
Genetic viral
Immunological
Environmental:
Radiation exposure
Chemicals
Other carcinogens
Leukemia TX
Multi drug chemo
Radiation
Bone marrow transplant
Goal of TX for leukemia
Preserve organ/system function
Remission
Control bone marrow/systemic disease
Targeted tx to specific system
Leukemia nursing care for risk of infection
Major cause of death
Initiate neutropenic precautions
Hand washing
Strict aseptic technique
Avoid invasive procedures
Common site’s :
RESP tract
GI
Skin
Signs of infection in leukemia pt, what to do next?
Notify provider immediately
Leukemia nursing care for Risk of bleeding🩸
During nadir
Risk when platelet is <50,000 cells/mm3
Maybe need platelet transfusion
Monitor labs, signs of bleeding
Fall precautions
Handle pt gently
Bleeding precautions
Leukemia nursing care for Fatigue & Nutrition
Small, frequent meals
⬆️ calorie
⬆️ protein
⬆️ carbs
Assist with ADLs PRN
Allow rest periods
Blood product administration per order
Check albumin
Leukemia nursing care as prescribed
Chemo administration
Abx administration
Blood product administration
Prepare pt for bone marrow transplant
Provide resources for psychosocial:
Financial
Family
Lymphomas
Neoplasms of T /B lymphocytes
Starts in:
Lymph nodes
Lymph tissue off spleen
GI tract
Liver
Bone marrow
Classified by degree of cell differentiation & origin of predominant malignant cell (Hodgkin vs Non)
Lymphoma non specific symptoms
Lymphadenopathy ***
Systemic:
Fever
Night sweats
Wt loss
Lymphoma other symptoms
Lots of appetite/anorexia
Fatigue
Resp distress/dyspnea
Itching
Hodgkin’s
Single or chain of lymph nodes
May metastasize to lymph tissue:
Tonsils
Spleen
Bone marrow
What Special characteristic is seen in Hodgkin’s?
Reed-Sternberg cell in nodes
Hodgkin’s possible exposures
Viral infection
Previous exposure to alkylating chemo
Hodgkin’s Clinical manifestations
Positive lymph node biopsy
Pruritis
Pain after alcohol consumption
Enlarged lymph nodes
Hepatosplenomegaly
Malaise, fatigue, weakness
Loss of appetite, significant wt loss
Fever, night sweats
Non-Hodgkin’s lymphoma (NHL)
Diverse group of blood cancers
Risk factors :
Immunodeficiencies
NHL stage I
In one lymph node or organ
NHL stage II
In _>_2 groups of nodes in same half of body
NHL stage III
In lymph nodes on both sides of the body
NHL stage IV
Spread outside of lymph node system into an organ that is not adjacent
NHL symptoms
Highly variable
May not appear until stage III or IV
Fever
Night sweats
Unintentional wt loss
Lymphadenopathy
NHL tx
Chemo
Radiation
Monoclonal antibodies
Intrathecal chemo
NHL nurse care
Monitor:
Labs
Client response to disease process
Client response to tx
Complications
Educate:
Tx regimen
Resources for support
Future annual screenings
Multiple myeloma
Cancer of plasma cells
Crowd space, not enough room for other cells
Develop into tumors
Destroy bone
Invade lymph nodes, spleen, liver
Where is multiple myeloma discoverable?
Blood & urine
Multiple myeloma signs
⬇️immunoglobulin
⬇️antibodies
⬆️Uris acid
⬆️calcium
Can lead to renal failure
Multiple myeloma etiology is…
Unknown
Multiple myeloma clinical manifestations
Bone pain:
Spine
Ribs
Pelvis
Osteoporosis, pathological fractures
Anemia
Thrombocytopenia
Granulocytopenia
Weakness
Fatigue
Renal failure
Infection
Neuro:
Confusion
Neuropathies
Multiple myeloma RX Tx
Chemo
Radiation
IV fluids
Diuretics
Blood transfusion (anemia)
Analgesics for pain
Antibiotics for infections
Multiple myeloma nurse care
Control symptoms
Prevent complications
Maintain neutropenic
Bleeding precautions
Fall precautions
Monitor for signs of:
Bleeding
Infection
Skeletal fracture
Renal failure
Normal calcium
Normal glucose
70-100
Lactic acidosis
Potassium levels
3.5-5
Normal WBC
Normal RBC
Normal platelets
Leukostasis
Congestion of immature white blood cells
Myelosupression
Bone marrow suppression
Hyperuricemic syndrome
⬆️uric acid in blood
Log in joins or renal system
Normal uric acid
2.4-7 mg/dL
Hyperuricemic syndrome may cause…
Acute gout arthritis
Renal urate Lithiasis
Acute uric acid nephrophathy
Host related risk factors for Hyperuricemic syndrome
Pre existing Hyperuricemia
Pre existing volume depletion/dehydration
CKD
ARF following cytotoxic therapy
Acidic urine
Tumor related risk factors for Hyperuricemic syndrome
⬆️tumor cell proliferation
⬆️tumor sensitivity to cytotoxic therapy
Large tumor burden
Advanced disease
Metastatic disease
Intensive cytotoxic therapy
S/s of acute attack during Hyperuricemic syndrome
Abrupt onset
Often at night
Severe pain
Redness
Swelling
Warmth of involved joint
Tx for Hyperuricemic syndrome
Prevent
Prophylaxis: allopurinol
Start 2 days prior to tx
Continue for 2 weeks
Protect
Adequate hydration
Reduce
Rasburicase for high risk pt
Already Hyperuricemic
Relieve
Painful inflammation
NSAIDs if no kidney/liver disease
Corticosteroids/colchicine if kidney
disease
TLS
Tumor lysis syndrome
Rapid necrosis of tumor cell
Massive intracellular material release into circulation.
Life threatening load of:
Hyperkalemia
Hyperurecemia
Hyperphosphatemia
Hypocalcemia
Acidosis
Azotemia
Ascites
Acute renal
Arrhythmias
Dx of TLS
⬆️Uric acid _>_476 or 8
⬆️K+ _>_6
⬆️Phos kids: _>_2.1, adult: _>1.45
⬇️<_1.75
AND 1 or more of these:
⬆️Crea >1.5
Dysthymias
Seizures (new onset)
Hyperkalemia s/s
Wide QRS complex**
Peak T waves**
ST changes**
Prolonged PR**
Loss of P wave**
Dysrhythmias
Htn
Sudden death
Muscle cramps/weakness
Paresthesia
Paralysis
Anorexia
NVD
Hyperactive bowel sounds
Abdominal pain or cramps
Hyperkalemia interventions
ABCs
Telemetry
Check ECG
Safety/fall risk
Verify IV access
C BIG K DI
Calcium Gluconate
Beta-2 agonists/bicarbonate
Kayexalate (slow)
Diuretics/dialysis/dextrose
Insulin
Hyperphosphatemia s/s
Htn
Dysrhythmias
Muscle cramps
Seizures
Tetany
Lethargy
NVD
Ca/Phos precipitates
Acute Renal Failure
Edema
Hyperphosphatemia interventions
IVF
Strict I/Os hourly
2ml/kg/hr
Daily wt
Seizure precautions
Telemetry
Restricted phos diet
Recheck labs Q4-6 hrs
PO phos binders:
Aluminum hydroxide
Aluminum carbonate
Calcium acetate
Hyperuricemia s/s
Htn
Endocarditis
Gout
Lethargy
Malaise
Somnolence
Seizures
Anorexia
NVD
Acute renal failure
Wt gain
Edema
Flank pain
Hematuria
Cloudy urine
Hyperuricemia interventions
IVF
Strict I/Os
Seizure precautions
Pain management
Hypocalcemia s/s
Dysrhythmia
Hypotension
Syncope
Muscle spasms
Muscle cramps
Positive Chvosteks/Trousseau
Paresthesia
Tetany
AMS
Confusion
Delirium
Hallucinations
Seizures
Anorexia
Diarrhea
Abd cramps
Laryngospasm
Bronco spasm
Hypocalcemia interventions
ABCs
Telemetry
Verify IV access
Safety/fall risk
Normal potassium
3.5-5
‼️WATCH OUT FOR ….. in TLS‼️
Acute decline in UOP
Oliguria
Anuria
CBC
Chem panel
Abg
Calcium
2.4-7
DIC
Disseminated IV coag
Systemic activation of coagulation
Leads to widespread thrombus formulation
Platelet & coat consumption =bleeding
DIC risk factors
Malignancy vs cytoxocity
Pregnancy
Sepsis
DIC labs in order
⬆️PT/PTT
⬆️INR
⬇️fibrinogen
⬇️platelet count
⬆️fibrin degradation products
⬇️Hct
Skin clinical manifestations in DIC
Micro emboli:
Cyanosis of digits or nose
Mottling
Necrosis
Gangrene
Coolness
Edema
Hemorrhagic :
Bleeding from venture sites, surgical incisions, mucous membranes, or draining tubes
Petechia
Epistaxis
Hematoma
Neurological clinical manifestations in DIC
Micro emboli:
Stroke
Alter level of consciousness
Confusion
TIA
Hemorrhagic :
Subarachnoid bleeding
Alter level of consciousness
Headache
Vascular clinical manifestations in DIC
Micro emboli:
Diminished or absent peripheral pulses
Tachycardia
Hemorrhagic :
Tachycardia
Hypotension
Pulmonary clinical manifestations in DIC
Micro emboli:
PE
Acute respiratory distress syndrome
Chest pain
SOB
Oxygen saturation
Hemorrhagic :
Hemoptysis
Bloody secretions from endotracheal tube
GI clinical manifestations in DIC
Micro emboli:
Borrow infarction
Constipation
Diarrhea
Melena
Vomiting
Abd distention
Hemorrhagic :
G.I. bleed
Abd distention
Occult blood
Renal clinical manifestations in DIC
Micro emboli:
Hematuria
Oliguria
⬆️BUN&Crea
Hemorrhagic :
Hematuria
DIC key management
- remove the trigger/treat underlining cause
- Maintain organ perfusion.
- Restore the balance of normal homeostasis.
- Provides supportive management of complications.
DIC tx
Treat underlining cause
Stop clotting
Lovenox Subcu
SCD
Low dose heparin infusion
Antithrombin III
Stop bleeding
Blood products: RBC, FFP,
Prevent
Antifibrinolytic agents
DIC total nursing interventions
Recognize
Asses/monitor
Protect/Prevent
Implement
Evaluate
Repeat
Malignant pleural effusion s/s
Crackles
SOB
Worsening dyspnea
Tripod
Nonproductive, dry cough
Orthopnea
Pain worse with breathing
Chest heaviness
Worsening activity tolerance
DOE
Malaise
Diminished breath sounds
Malignant pleural effusion interventions
ABG*****
O2 sat
Asscultate front & back
Pain
Positioning
Imaging
Malignant pleural effusion tx
Centesis
Fluid drainage below area
Check for therapeutic outcome:
ABCs
pain relief
Drainage amount
Chemo/radiation/sx
Malignant cardiac tamponade s/s
SOB
Fatigue
Restlessness
Palpitation
Symptoms of pericarditis
Beck’s triad in Malignant cardiac tamponade
JVD
Poor Cardiac output
Tachycardia w/ low BP
Poor peripheral perfusion
Distant muffled heart sounds
Becks triad
TLS
Rapid necrosis of tumor cells
Release of massive intracellular material into circulation
TLS signs
⬆️hyperkalemia
⬆️Hyperuricemic
⬆️hyperphosphatemia
⬇️calcemia
Acidosis
Dx Malignant cardiac tamponade
CXR
ECG
Echocardiogram
Tx Malignant cardiac tamponade
Needle pericardiocentesis
Pericardial catheter
Pericardial window
Pericardiocentesis nursing interventions
Continue to monitor patient
There will be more fluid build up
Tele: Continuous cardiac monitoring
Assess/monitor for complications:
Dysrhythmias
Hemothorax
Pneumothorax
Coronary artery puncture
Lung puncture
VS:
Q15 x2
Q30 x2
Q1h x2 complications immediately
Q4 as less drainage/abscence effusion
Drainage
Bag at or below heart level
Monitor cath for occlusion
Assess characteristics of drainage
Cath care: sterile dressing, change only if soiled or after 96 hrs!!
Normal calcium
8.8-10.4
Hypercalcemia s/s
Constipation
Arrhythmia
Confusion
Lethargy
Pathological fractures
Principles of managing hyperkalemia
Stabilize
Calcium gluconate *immediate
Shift
Insulin 15-30min
Albuterol 15-30mim
Eliminate
Furosemide (lasix)15min-1hour
Kayexalate *1-2 hrs
Symptomatic Hypocalcemia tx
Calcium gluconate lowest dose
